PT  - JOURNAL ARTICLE
AU  - Bateman, Eric D.
AU  - Price, David B.
AU  - Wang, Hao-Chien
AU  - Khattab, Adel
AU  - Schonffeldt, Patricia
AU  - Catanzariti, Angelina
AU  - van der Valk, Ralf J. P.
AU  - Beekman, Maarten J.H.I.
TI  - Short-acting β<sub>2</sub>-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study
AID  - 10.1183/13993003.01402-2021
DP  - 2021 Jan 01
TA  - European Respiratory Journal
PG  - 2101402
4099  - https://publications.ersnet.org//content/early/2021/09/09/13993003.01402-2021.short
4100  - https://publications.ersnet.org//content/early/2021/09/09/13993003.01402-2021.full
AB  - Background To gain a global perspective on short-acting β2-agonist (SABA) prescriptions and associated asthma-related clinical outcomes in patients with asthma, we assessed primary health data across 24 countries in 5 continents.Methods SABINA III was a cross-sectional study that employed electronic case report forms at a study visit (in primary or specialist care) to record prescribed medication(s), over-the-counter (OTC) SABA purchase, and clinical outcomes in asthma patients (≥12 years old) during the past 12 months. In patients with ≥1 SABA prescription, associations of SABA with asthma symptom control and severe exacerbations were analysed using multivariable regression models.Results Of 8351 patients recruited (n=6872, specialists; n=1440, primary care), 76.5% had moderate-to-severe asthma and 45.4% experienced ≥1 severe exacerbation in the past 12 months. Thirty-eight percent of patients were prescribed ≥3 SABA canisters; 18.0% purchased OTC SABA, of whom 76.8% also received SABA prescriptions. Prescriptions of 3–5, 6–9, 10–12 and ≥13 SABA (versus 1–2) were associated with increasingly lower odds of controlled or partly controlled asthma (odds ratio [95% CI]: 0.64 [0.53–0.78], 0.49 [0.39–0.61], 0.42 [0.34–0.51] and 0.33 [0.25–0.45], respectively; n=4597) and higher severe exacerbation rates (incidence rate ratio [95% CI]: 1.40 [1.24–1.58]; 1.52 [1.33–1.74]; 1.78 [1.57–2.02]; 1.92 [1.61–2.29], respectively; n=4612).Conclusions This study indicates an association between high SABA prescriptions and poor clinical outcomes across a broad range of countries, healthcare settings and asthma severities, providing support for initiatives to improve asthma morbidity by reducing SABA over-reliance.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: EDB is a member of the Science Committee and Board of GINA and reports personal fees from ALK, AstraZeneca, Boehringer Ingelheim, Chiesi, Menarini, Novartis, Orion, Regeneron Pharmaceuticals and Sanofi Genzyme.Conflict of interest: DBP has board membership with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Mylan, Mundipharma, Novartis, Regeneron, Sanofi Genzyme, Teva Pharmaceuticals and Thermofisher; consultancy agreements with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline (GSK), Mylan, Mundipharma, Novartis, Pfizer, Teva and Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Mylan, Mundipharma, Novartis, Pfizer, Regeneron, Respiratory Effectiveness Group, Sanofi Genzyme, Teva, Theravance and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GSK, Kyorin, Mylan, Mundipharma, Novartis, Regeneron, Sanofi Genzyme and Teva; payment for the development of educational materials from Mundipharma and Novartis; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Mundipharma, Mylan, Novartis and Thermofisher; funding for patient enrolment or completion of research from Novartis; stock/stock options from AKL Research and Development Ltd, which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); is a peer reviewer for grant committees of the Efficacy and Mechanism Evaluation programme and Health Technology Assessment; and was an expert witness for GSK.Conflict of interest: H-CW has nothing to disclose.Conflict of interest: AK has nothing to disclose.Conflict of interest: PS reports lectures on medical education and inclusion as a researcher on clinical study protocols funded by AstraZeneca, GSK, Teva, ITF Labomed, Boehringer Ingelheim and Sanofi Genzyme.Conflict of interest: AC is employee of AstraZeneca.Conflict of interest: RJPvdV is employee of AstraZeneca and has shares in GSK and shares and options in AstraZeneca.Conflict of interest: MJHIB was an employee of AstraZeneca at the time the study was conducted and has shares in AstraZeneca.